Arthroscopic treatment for limitation of motion of the elbow: the learning curve

The aim of this study was to demonstrate our learning curve in arthroscopic treatment for limitation of motion of the elbow.

To verify the surrogates for learning curve, operative time in 120 consecutive elbows were plotted by case number and the learning curve was illustrated by the best-fit curve. The study population was divided into eight consecutive blocks (15 patients per block) by observing a notable change in the learning from the curve. Mean operative time and mean improvement in motion and clinical score in each block were compared.

Mean operative time decreased significantly from the first block to the second block (133-98). No further significant change was noted thereafter. Contrarily, no significant increase in motion improvement or clinical score improvement was identified but a significant decrease was found between the fourth and fifth block (47-36 and 30-24, respectively). Operative time was negatively correlated with preoperative range of motion (P=0.003). Clinical score improvement was also negatively correlated with preoperative range of motion (P<0.001). Motion improvement was more strongly correlated with preoperative range of motion (P<0.001).

This study demonstrated a learning curve in which a significant decrease in operative time was shown after an initial 15 patients. Motion and clinical score improvement were not satisfactory surrogate for learning curve and found to be closely related to preoperative range of motion. Qualification of the learning curve for arthroscopic treatment for limitation of motion of the elbow provides a guide for surgeons assuming the expected time line to become proficient in this technique.